| NPI | 1326301078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: DC RN1031389) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2023-06-22 |